End of the 51st Cycle of Pomalidomide (CC-4047):
As often happens, some of the myeloma blood markers are up this month, some down. M-Spike is down from 1.2 to 1.1 g/dL, but IgG is up from 1190 to 1280 mg/dL. I don't know which to believe, so I'm calling it a draw, meaning "stable" in cancer lingo. For good measure, Lambda light chains are down from 2.24 to 1.99 mg/dL, while Kappa chains went up, making the ratio go up, which in my case is good. I think. Maybe. As Dr L said, "We'll take it."
I take a little capsule containing 2 mg of pomalidomide every night, and every 28 days my family and I drive the 80 miles to Mayo Clinic in Rochester, where I have blood tests and the occasional ECG or X-ray. Next month will mark four full years on the pomalidomide study. I'm a satisfied customer!
Some of the discussion with Dr. L:
Peripheral Neuropathy (PN):
- A previous doc at Mayo had given me a prescription for bactrim, an antibiotic, to be taken daily to ward off a pneumonia which attacks people with compromised immune systems. Dr. L gives the same prescription for people in my situation when dexamethasone (DEX) is part of the regimen, but not otherwise, and I am no longer taking DEX, so she did not renew the prescription. OK, the fewer medications the better.
- I mentioned to Dr. L that the neuropathy in my fingers is slowly advancing. For example, I recently felt a suspicious blueberry between thumb and forefinger to see if it was soft or firm, but I couldn't tell without picking it up to check it more closely. She asked if I had tried acupuncture, and remarked that a few of her other patients seemed to have some success with it. I might try it, but right now the neuropathy doesn't really affect my quality of life. Yet.
- Calcium was up again, slightly above the reference level. Dr. L thought it might be due to slight dehydration, especially since my blood draw was at 10 am rather than the usual 6 am and I can't take fluids until the blood draw. I think that's probably right. Anyway I have a skeletal survey and a bone density test scheduled for next month, so if the calcium is an indicator of bone loss, there is a pretty good chance of catching it.
The International Myeloma Working Group (IMWG) recently issued Guidelines for the Management of Treatment-Emergent Peripheral Neuropathy in Multiple Myeloma. This is a very comprehensive document which I recommend to anyone dealing with neuropathy caused by myeloma treatments. It discusses drugs, supplements, physical therapy, acupuncture, chemotherapy dose modification, and even prevention of PN. It's a guide for both doctors and patients.
If that link doesn't work, use this one, a verbatim copy of just the document, on another web site.
Some Recent Test Results:
||\ Tumor marker
||/ Tumor marker
||L Free light chains
||Red cells, low
||White cells, normal